Key result
Delayed pacemaker atrial lead perforation combined with warfarin therapy caused recurrent pericardial effusion seven years after device implantation.
Late pacemaker lead perforation can present as recurrent pericardial effusion, which may be unmasked or exacerbated by the introduction of anticoagulation therapy such as warfarin.
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Clinicians should consider delayed atrial lead perforation in recurrent effusion years post-implant on anticoagulation; this case leaves incidence and management open.
A 66-year-old man was implanted with a pacemaker. Seven years after implantation he was admitted due to cardiogenic cerebral embolism and warfarin therapy was introduced. After that, he suffered recurrent pericardial effusion for unexplained reasons. An exploratory thoracotomy revealed that the screw of the atrial lead had penetrated through the right auricular appendage wall.
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Nakanishi et al. (2012) studied this question. Delayed pacemaker atrial lead perforation combined with warfarin therapy caused recurrent pericardial effusion seven years after device implantation.
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